Healthy Wednesday: Douglas County group forms to prevent diseases

NICHOLAS JOHNSON/The News-Review
Helen Walker, 87, of Roseburg exercises in January at Active Life Fitness Center in Roseburg. Exercise is a key component to preventive medicine, which is a major emphasis of the recently formed Umpqua Health Alliance.

BODY MASS INDEX: This simple test can be performed online. Enter your height and weight into the National Institutes of Health’s online BMI calculator to find out if you are overweight or obese. Carrying around extra pounds increases risk for more serious problems like diabetes and heart disease.

HIGH BLOOD PRESSURE: Starting at 18, every two years. High blood pressure is 140/90 or higher.

DIABETES: If you have high blood pressure.

COLORECTAL CANCER: Beginning at 50.

CHOLESTEROL: MEN: Beginning at 35. MEN AND WOMEN: Older than 20, if they are obese, smokers or have other risk factors for heart disease.

BREAST CANCER: WOMEN: Every other year between the ages of 50 and 74.

CERVICAL CANCER: WOMEN: Every one to three years.

OSTEOPOROSIS: WOMEN: At 65.

ABDOMINAL AORTIC ANEURYSM: MEN: One time between 65 and 75, should be tested for bulging in the body’s largest artery, located in the abdomen.

HIV: If you have had unprotected sex with more than one partner, if you or your partner are HIV-infected or inject drugs or if you had a blood transfusion between 1978 and 1985.

SOURCES: The Agency for Healthcare Research and Quality and the U.S. Preventive Services Task Force. Standard screening tips assume the patient has no symptoms of illness. See your doctor for advice tailored to your personal and family health history.

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It has become a frequent catch phrase in medical circles. Doctors urge us to get more of it. Newly formed coordinated care organizations claim it is one of the secrets to cutting costs while improving patient care.

The term is “preventive care,” but what does it mean, really? And how do you know whether you are getting enough of it?

Doctors serving low-income patients have devoted a lot of attention to the topic in the past year.

It is one of the goals of the recently formed Umpqua Health Alliance, an organization whose mission is to coordinate care for 22,000 Douglas County residents on the Oregon Health Plan. One of the keys to the alliance’s success, according to its founders, will be monitoring its patients in the early stages of illness or before they get sick. The goal is to ensure they receive care necessary to avoid more dangerous—and costly—medical problems down the road.

“We’re trying to be more proactive in reaching out to patients for getting those checks,” said Christi Parazoo, practice manager for the Umpqua Community Health Center, one of the Alliance’s member organizations.

Marilyn Carter, public health promotion manager for the Douglas County Public Health Division, said patients should also be proactive about prevention.

“When you talk preventive, it’s not just going in and having your doctor tell you, ‘You need this test.’ It’s you knowing before you go in what kind of screening you need,” Carter said.

That can be tough, given the wealth of sometimes conflicting information available, according to Roseburg pediatrician Dr. Bob Dannenhoffer.

“There’s so many people out there telling you what they think. I think it’s really confusing to people. There’s so much advice. Who do you trust to look through all the data and tell you what you should and shouldn’t do?” said Dannenhoffer, who is CEO of Architrave Health, a joint venture of Mercy Medical Center and DCIPA, The Physicians of Douglas County, and one of the founding members of the Umpqua Health Alliance.

Dr. Dannenhoffer’s prescription is, “If you smoke, stop. If you’re not smoking, don’t start. Get some exercise and talk to your doctor about everything else.”

For those who want more information about staying on top of their own care, Carter recommends the Agency for Healthcare Research and Quality. Dannenhoffer suggests the U.S. Preventive Services Task Force. The two federal programs are interconnected and give patients and doctors similar tips. The agency offers easy-to-read pamphlets online. The task force grades common recommendations and provides in-depth analysis of evidence supporting its conclusions.

Federal recommendations largely boil down to three factors—screenings, immunizations and healthy behaviors.

Some important disease prevention happens at home.

Healthy behaviors like exercising, eating right and avoiding tobacco are well-known ways to avoid chronic ailments in the first place. Limiting alcohol is important too. For men older than 65 and women of all ages, that means no more than one drink a day. For younger men, no more than two.

Screenings for high blood pressure, diabetes, cholesterol and cancer are important to maintaining health. So are annual flu shots and, for those 65 and older, pneumonia shots.

For keeping kids well, Dannenhoffer said standard immunizations, an active lifestyle and fluoride treatments have proven highly effective. Children 3 to 5 years old should also have their vision checked, he said.

What if you’re already sick? Many Douglas County residents are already struggling with health conditions like diabetes or asthma.

“Few of us are so healthy we don’t have one thing wrong with us,” Carter said. “Preventing conditions is one thing, but there’s also the issue of preventing worsening conditions.”

A series of six-week courses hosted by the Umpqua Community Health Center aims to help patients do that. The program is called Living Well with Chronic Conditions.

Program manager Cindy Norona said patients of any age with chronic health issues are welcome in the courses, though most are seniors. Each class is made up of people with a mix of conditions, ranging from back pain to arthritis and asthma to diabetes.

Norona teaches strategies that can help them solve common problems associated with all of them. Many work to lose weight, overcome fatigue and depression and communicate effectively with doctors.

Small, achievable goals are the key to success. Something as simple as planning to walk the dog 10 minutes a day three days a week can be a great start to better health, Norona said.

Sometimes a big goal like losing 50 pounds or taking up jogging seems so overwhelming the patient never begins, she said.

“So they continue to drink pop and eat fries and sit on the couch saying, ‘I’m never going to lose 50 pounds,’ ” Norona said. “We try to get people to break things down into small parts.”

In February, Norona became licensed through a Stanford course as a master trainer. She can now train others to lead the programs locally.

The program is based on Stanford University’s Chronic Disease Self-management Program. The program was developed through research at the university’s medical school. According to the university’s website, its long-term study showed the program saved $4 in health care costs for every dollar spent.

Perhaps more important, Norona said people who go through the program feel more in control of their conditions and are able to live fuller lives.